THE    NORMAL  SCHOOL 
QUARTERLY 


Series  14  October,  1915  Number  57 


Methods  of  Testing  School 

Children  for  Defects  of 

Vision  and  Hearing 


By 


HARVEY  A.  PETERSON,  Ph.  D. 


PUBLISHT    JANUARY,    APRIL,    JULY,    AND    OCTOBER    OF    EACH 

YEAR  BY  THE  ILLINOIS  STATE  NORMAL  UNIVERSITY, 

NORMAL,   ILLINOIS 


Enterd  August,  1902,  at  Normal,  Illinois,  as  second-class  mail  matter  under 
Act  of  Congress  of  July  16,  1894 

N.  B. — Any  teacher  In  Illinois  may  get  the  Normal  School  Quarterly  regularly 
by  sending  exact  name  and  address,  and  by  giving  prompt  notis  of  any  change  of 
address. 

Simplified  spellings  are  used  in  the  offisial  publications  of  the  Illinois  State 
Normal  University. 


Normal  School  Quarterly 


-. 


methods  cf  tist:ng  schcol  oh:ldrf\ 

FOR  DZ.FZCT5   OF  \*I5ION  AND  HEARING 

I: 
Haevet  A    ?   rz:  Ph.  D. 


One  of  the  four  or  five  most  important  fases  of  educa- 
tional progress  at  the  present  day  is  the  more  efficient  care 
of  the  helth  of  children  by  the  school  authorities.     The 
working  out  of  this  ideal  has  taken  a  number  of  forms 
cording  to  the  needs  of  children  in  their  relation  to  the 
school.      Thus    we    have    medical    inspection,    improved 
school  and  personal  hygiene,  the  playground  movei 
and  mental  tests  of  intelligence  with  special  classes  for  sub- 
normal children.    It  is  the  purpose  of  this  bulletin  to 
with  a  part  of  medical  inspection  with  which,  in  the  pr  bs 
stage  of  the  movement,  teachers  have  a  good  deal  t 
and  for  which  in  many  pla«:  are  responsible.    I  refer 

to  tests  of  the  sight  and  hearing  of  child: 

•ileal   inspection   of  schools   :  -in  public 

with  remarkable  rapidity  rding  to  an  in 

gation  made  in  1911  by  the  Russe     ^    a     Foundation  and 
reported  by  Gulick  and  Ayres  in  their  Medical  I 
Schools  there  :n  1894  four  cities  which  had  medical 

inspection:  in  1899  there  were  nine;  in  1904,  thir 
in  1909.  two  hundred  and  sixty-three;    and  in  1911.  four 
hundred  eleven.     Thirty-two  more  cities  had  medical  in- 
spection but  did  not  report  when  it  had  been  establisht.    It 
is  safe  to  say  that  in  1911  not  far  from  forty  per  c?nt  of  all 


2  The  Normal  School  Quarterly 

the  cities  in  the  United  States  had  medical  inspection.  Tests 
of  sight  and  hearing  are  always  included  in  medical  inspec- 
tion and  along  with  the  examination  of  nose,  throat,  and 
teeth,  are  regarded  as  the  most  important  part  of  the  in- 
spection. Indeed  the  tests  of  sight  and  hearing  are  older 
and  much  more  widely  establisht  than  the  other  examina- 
tions mentiond;  for  while  443  cities  had  medical  inspection, 
810  out  of  1038  had  tests  of  sight  and  hearing. 

In  such  movements  as  this,  city  school  systems  nearly 
always  take  the  lead.  Yet  the  movement  is  well  under  way 
in  the  state  systems.  According  to  the  same  report  seven 
states  required  medical  inspection  in  all  their  public  schools 
in  1911.  They  were  Colorado,  Indiana,  Maine,  Massachu- 
setts, Minnesota,  Rhode  Island,  and  Utah.  Thirteen  more 
had  past  laws  permitting  school  funds  to  be  used  for  medical 
inspection.  Permissiv  laws  in  such  matters  usually  be- 
come mandatory  before  long.  It  is  not  the  purpose  of  this 
bulletin  to  go  into  the  reasons  for  and  against  tests  of  sight 
and  hearing  by  the  school.  The  same  reasons  which  justify 
education  by  the  state  justify  whatever  conditions  are  nec- 
essary and  proper  to  secure  it,  providing  it  can  be  shown 
that  the  school  can  provide  the  conditions  more  efficiently 
than  the  parents,  or  that  providing  the  conditions  free  for 
some  children  and  not  for  others  is  contrary  to  our  demo- 
cratic ideals.  School  tests  of  sight  and  hearing  are  neces- 
sary because  in  many  cases  neither  the  children  nor  their 
parents,  unaided,  are  likely  to  discover  the  defects  for  years. 
Many  parents  need  the  stimulus  of  a  note  from  the  principal 
or  school  physician  to  induce  them  to  take  their  children  for 
treatment. 

When  the  tests  are  made  by  physicians  undoutedly 
they  are  more  reliable  than  when  conducted  by  teachers. 
Possibly  when  public  opinion  is  sufficiently  educated,  physi- 
cians will  do  most  of  the  work.  At  the  present  time,  how- 
ever, particularly  in  the  rural  and  small  town  schools  of 
Illinois,  public  sentiment  is  not  strong  enuf  to  support  free 
medical  inspection.  Meanwhile  it  is  possible  for  the  teacher 
to  be  of  great  servis.  With  very  little  training,  even  such  as 
this  bulletin  provides,  he  can  discover  the  children  whose 
sight  or  hearing  is  sub-normal,  determin  how  serious  the 


Testing  School  Children  for  Vision  and  Hearing  3 

defect  is,  and  if  serious  enuf,  advize  the  parents  to  consult 
a  physician.  Aside  from  the  great  improvement  in  school 
work  which  usually  results,  this  is  one  of  the  most  effectiv 
ways  of  developing  a  sentiment  in  favor  of  medical  inspec- 
tion. Even  after  this  is  secured,  in  many  places  the  teacher 
continues  to  make  the  preliminary  examination,  in  order 
that  the  children  who  need  attention  may  not  be  obliged  to 
wait  on  the  necessarily  slow  progress  of  the  physician's 
systematic  examination  of  the  whole  school.  The  oculists 
and  aurists  whom  the  Massachusetts  legislature  consulted 
in  framing  their  law  on  the  subject  advized  that  the  annual 
tests  of  vision  and  hearing  be  conducted  by  the  teachers. 
Gulick  and  Ayres  approve  of  this  in  their  recommendations 
to  those  who  are  contemplating  legislation.  According  to 
their  investigation  teachers  test  the  sight  and  hearing  in  552 
out  of  810  cities,  and  in  five  of  the  seven  states  requiring 
these  tests. 

I  have  shown  that  medical  inspection  with  the  teacher 
as  an  assistant  is  growing  rapidly.  In  the  Elementary 
Training  School  of  the  Illinois  State  Normal  University  the 
sight  and  hearing  of  the  children  have  been  tested  annually 
for  the  last  three  years.  In  the  examination  a  year  ago 
forty  children,  which  is  ten  per  cent  of  the  enrolment,  were 
found  seriously  enuf  defectiv  in  sight  to  warrant  recom- 
mending to  the  parents  that  a  professional  examination  be 
made.  During  the  next  twelve  months  the  parents  of  fifty 
per  cent  of  the  children  acted  upon  the  advice  and  had  a 
professional  examination  made.  According  to  the  teachers 
much  benefit  has  resulted  both  in  helth  and  in  the  efficiency 
of  the  children's  work.  Glasses  were  secured  by  many, 
treatment  given,  and  further  damage  by  use  of  the  eyes  in 
improper  condition  has  been  prevented.  Is  it  not  worth 
your  while  to  acquire  the  ability  and  start  such  tests  in  your 
school?  We  shall  next  describe  how  to  procede  in  initiat- 
ing the  work. 

1        METHOD  OF  TESTING  SIGHT  WITHOUT  LENSES 

The  work  requires  a  room  well  lighted  and  long  enuf 
to  enable  the  person  tested  to  sit  six  meters,  or  twenty  feet, 
from  the  charts.    A  Lowell  letter  chart  and  a  Verhoeff  astig- 


4  The  Normal  School  Quarterly 

matic  chart  are  also  needed.  These  may  be  obtaind  at  small 
cost  from  the  supply  houses  mentiond  at  the  end  of  this 
bulletin. 

Place  the  charts  in  a  good  light  on  a  level  with  the 
child's  eyes  when  seated.  The  light  should  come  from  the 
side  or  rear  of  the  child;  if  the  latter,  there  should  be  no 
glare  in  his  eyes.  Direct  sunlight  should  not  be  used.  If 
an  artificial  light  has  to  be  used,  place  it  near  the  charts, 
avoiding  glare,  and  tying  a  piece  of  cardboard  in  front  of 
it  to  shield  the  child's  eyes.  If  there  are  other  children  wait- 
ing to  be  tested,  seat  them  far  enuf  away  to  prevent  their 
hearing  the  reading  of  the  letters. 

Seat  the  child  twenty  feet  from  the  charts  and  cover 
his  right  eye  with  a  bandage.  If  he  wears  glasses  test  him 
with  them  on,  tying  a  cardboard  blind  over  the  right  eye 
and  slipping  it  down  inside  the  glasses,  taking  care  that  it 
does  not  interfere  with  winking.  Tell  him  to  read  the  letter 
chart  from  left  to  right,  beginning  with  the  line  numbered  8. 
If  he  can  read  all  of  this  correctly,  record  the  vision  of  the 
left  eye  as  normal.  If  he  misses  a  letter  he  should  procede 
to  the  next  coarser  line,  and  so  on,  until  he  can  read  a  line 
without  any  errors.  The  fraction  opposit  this  line  on  the 
left  side  of  the  chart  indicates  his  fraction  of  normal  vision, 
8-10,  6-10,  etc.,  and  should  be  recorded. 

Now  test  the  same  eye  for  astigmatism.  Ask  the  child 
to  look  at  the  astigmatism  chart,  and  tell  whether  some  of 
the  radiating  lines  appear  clearer  and  blacker  than  the  rest. 
If  so,  astigmatism  is  present,  and  the  diameter  of  greatest 
clearness  indicates  the  type  of  astigmatism.  Vertical  as- 
tigmatism is  the  most  common  type.  Record  the  diameter 
of  greatest  clearness,  using  the  numbers  around  the  rim  of 
the  chart.  If  all  the  lines  are  blurd,  have  him  approach  the 
chart  and  record  the  diameter  that  first  becomes  clear. 

Test  the  right  eye  in  the  same  way.  The  following  is  a 
sample  of  the  kind  of  records  which  the  teacher  should 
have:  "Grade  V.  John  Snow.  Sept.  18,  1914.  Left  eye  I. 
No  astig.  Right  eye  8-10.  Astig.  3-3."  The  I.  after  the 
words  "left  eye"  means  normal  sight;  the  3-3  indicates  the 
diameter  of  greatest  clearness  in  the  astigmatism  test. 

Distinguishing  hyperopia  and  myopia  without  lenses. — 


Testing  School  Children  for  Vision  and  Hearing  5 

It  is  desirable,  but  not  necessary,  for  the  teacher  to  be  able 
to  distinguish  hyperopia  (far-sightedness)  and  myopia 
(near-sightedness)  from  each  other,  in  order  to  give  the 
child  a  favorable  seat  until  he  obtains  glasses.  The  best 
way  to  distinguish  them  is  with  the  aid  of  lenses,  as  de- 
scribed in  the  next  section.  Lenses  are  moderately  expensiv, 
but  easy  to  use  for  this  purpose.  Extreme  hyperopia  and 
myopia  can  often  be  distinguisht  by  the  distance  at  which 
the  child  holds  his  book.  The  normal  distance  is  about 
twelv  to  fourteen  inches.  The  extremely  myopic  child  holds 
the  book  nearer,  the  extremely  hyperopic  child,  farther 
away. 

If  astigmatism  is  shown  by  the  Verhoeff  chart  to  be 
absent,  inability  to  read  ordinary  writing  on  a  blackboard 
twenty  feet  away  indicates  myopia,  while  hedake  and  in- 
flamed eyelids  indicate  hyperopia.  If  the  child  is  near- 
sighted seat  him  near  the  blackboard  until  glasses  are 
secured,  and  perhaps  even  afterwards,  as  glasses  cannot 
always  entirely  correct  the  defect.  If  he  is  far-sighted,  give 
him  as  little  fine  work  at  close  range  as  possible  until  glasses 
are  secured. 

Squint. — Squint  is  of  two  varieties,  internal  and  ex- 
ternal, the  internal  being  commonly  known  as  "cross- 
eyedness."  The  internal  form  is  due  to  far-sightedness, 
the  extreme  effort  at  accommodation  which  the  far-sighted 
person  makes  bringing  with  it  reflexly  an  extreme  con- 
vergence. External  squint  is  similarly  due  to  near-sighted- 
ness. In  case  there  is  a  doubt  as  to  whether  a  child  squints, 
cover  one  eye,  have  him  fixate  something  with  the  other 
eye,  and  notis  whether  his  line  of  vision  changes  as  the 
covered  eye  is  uncovered.  If  so,  there  is  squint.  The  defect 
is  one  which  should  be  remedied  early  because,  if  allowd 
to  continue,  the  eye  affected  becomes  blind.  The  teacher 
should  consequently  always  advize  treatment. 

II.      METHOD  OF  TESTING  SIGHT  WITH  LENSES 

As  above  stated  this  is  the  easiest  and  most  satisfactory 
way  of  distinguishing  hyperopia  and  myopia.  A  trial  frame 
(lens  holder)  and  set  of  lenses  can  be  procured  for  $9.00 
from  the  supply  houses  (See  last  page).    The  procedure  is 


6  The  Normal  School  Quarterly 

the  same  as  the  test  with  charts  alone  except  that  a  solid 
disc  put  into  the  trial  frame  takes  the  place  of  the  bandage 
or  cardboard  blind.  If  the  person's  sight  is  shown  by  his 
reading  of  the  letter  chart  to  be  sub-normal  (less  than  1), 
the  convex  lens  (nickel-rimd,  markt  plus  75)  should  be 
tried.  If  it  aids  vision,  or  does  not  impair  it,  the  eye  is  far- 
sighted.  If  the  concave  lens  (copper-rimd,  markt  minus 
75)  aids,  the  eye  is  near-sighted.1  Put  the  trial  frame  on  the 
child,  cover  the  unused  eye  with  a  solid  disc,  clean  the 
lenses,  put  one  of  them  into  the  frame.  Then  adjust  the  set 
screws  so  that  the  pupil  of  the  eye  is  opposit  the  center  of 
the  lens.  Have  the  person  read  the  chart  again,  and  record 
the  result.  Both  the  ability  to  read  finer  print  with  the 
lens  than  without  it  and  the  testimony  of  the  person  as  to 
whether  the  print  is  clearer  or  not  are  useful  in  deciding 
whether  he  is  improved ;  but  the  former  is  the  chief  reliance. 
If  the  vision  is  defective  but  neither  lens  aids,  the  de- 
fect is  something  else  than  myopia  or  hyperopia,  and  should 
be  recorded  as  "Neither."  A  far-sighted  person  can,  how- 
ever, pass  the  test  (read  the  8th  line)  by  a  very  strong  con- 
traction of  the  ciliary  muscle.  This  is  cald  latent  hyper- 
opia, and  is  not  easy  for  the  teacher  to  detect.  The  oculist 
uses  drugs  to  paralyze  the  ciliary  muscle  temporarily. 

COMPARISON  OF  THE  LOWELL  AND  SNELLEN  TEST  CARDS 

By  some  examiners  Snellen's  chart  is  used.  The  dis- 
tance at  which  each  line  of  the  chart  can  be  red  by  the  nor- 
mal eye  is  given,  and  if  the  forty-foot  line  is  the  smallest 
print  that  the  person  can  read  at  twenty  feet,  his  vision  is 
said  to  be  20-40  of  normal,  if  the  sixty-foot  line  is  the  small- 
est print,  20-60  of  normal,  etc.  In  principle  this  chart  is 
the  same  as  the  Lowell  chart  recommended  above.  The 
eighth  line  in  the  Lowell  chart  and  the  twenty-foot  line  in 
the  Snellen  chart  are  the  same  size  print,  viz.,  the  smallest 
print  that  the  normal  eye  can  read  at  twenty  feet.  Now  the 
linear  size  of  an  object  decreases  directly  as  the  distance 


i  Another  way  of  distinguishing  convex  and  concave  lenses  is  to  move  them 
up  and  down  over  print.  The  print  moves  with  the  concave  lens  and  in  the  direction 
contrary  to  the  convex  lens. 


Testing  School  Children  for  Vision  and  Hearing  7 

increases,  that  is  to  say,  at  twice  the  distance  the  object 
appears  only  one-half  as  high  or  wide.  Consequently  in 
order  for  letters  on  the  Snellen  card  to  be  read  by  the  normal 
eye  at  forty  feet,  they  hav  to  be  twice  as  large  in  linear  size 
as  at  twenty  feet.  Now  if  the  forty-foot  print  is  the  small- 
est that  the  person  being  tested  can  read  at  twenty  feet,  his 
vision  is  only  one-half  or  20-40  normal.  The  Lowell  chart 
calls  this  forty-foot  print  5-10.  The  100-foot  print  on  the 
Snellen  chart  and  the  2-10  on  the  Lowell  chart  are  of  the 
same  size,  and  the  200-foot  line  on  the  former  corresponds 
to  the  1-10  on  the  latter.  The  other  lines  on  the  two  charts 
do  not  correspond  in  distances  chosen. 

//  is  unnecessary  and  undesirable  in  using  either  chart 
to  try  the  child  at  other  distances  than  twenty  feet,  except 
in  the  case  mentiond  above  where  all  the  radiating  lines  of 
the  astigmatism  chart  appear  blurd.  One  cannot  distin- 
guish myopia  and  hyperopia  from  each  other  by  this  means. 

SIZE   OF   PRINT 

It  is  a  matter  of  much  importance  for  teachers  to  know 
the  size  of  print  in  which  children's  books  should  be  printed. 
The  following  quotation  from  Dr.  A.  G.  Young's  Seventh 
Annual  Report  as  Secretary  of  the  Maine  State  Board  of 
Helth,  given  in  Dresslar's  School  Hygiene  answers  the 
question. 

Books  printed  from  type  smaller  than  "long  primer1'  should 
never  be  put  into  the  hands  of  pupils  of  any  grade,  and  those  for 
young  children  should  be  printed  from  "pica'1  or  "great  primer".. 
Full-faced  roman  type  is  much  more  suitable  than  the  "light- 
faced"  type  now  so  much  in  favor. 

The  distance  of  the  letters  from  each  other  should  not  be 
too  slight  and  the  different  words  in  the  same  line  should  stand 
far  enuf  apart  to  enable  the  eye  rapidly  and  easily  to  take  in  the 
picture  of  each.  The  distance  of  line  from  line  should  not  be  less 
than  2.5  millimeters,  disregarding  the  longer  letters,  and  Gohn 
prefers  three  millimeters  (%  inch).  When  lines  are  cf  too  great 
length,  the  eye  has  a  difficulty  in  running  back  to  the  beginning 
of  the  next  line.  Some  authorities  state  that  the  length  of  line 
should  not  excede  100  millimeters  (3%  inches);  others,  as  ap- 
pears to  me  more  wisely  for  schoolbooks,  place  the  limit  at  80 
or  90  millimeters  (3%  or  3V2  inches). 


8  The  Normal  School  Quarterly 

PBARL,  as  the  printers  call  it,  is  unfit  for  any  eyes,  yet  the  piles  of  Bibles  and  Testaments  annu. 
ai/y  printed  in  it  tempt  many  eyes  to  self-destruction. 

Agate  is  the  type  in  which  a  boy.  to  the  writer's  knowledge,  undertook  to  read  the  Bible 
thru .  His  outraged  eyes  broke  down  with  asthenopia  before  he  went  far  and  could  be  used  but 
little  for  school  work  the  next  two  years. 

Nonpareil  is  used  in  some  papers  and  magazines  for  children,  but  to  spare  the 
eyes,  all  such  should,  and  do.  pro  on  the  list  of  forbidden  reading- matter  in  tlio^e homes 
where  the  danger  of  such  print  is  understood. 

Minion  is  read  by  the  helthy,  normal  young-  eye  without  appreciable  diffi- 
culty, but  eyeii  to  the  sound  eye,  the  danger  of  strain  is  so  great  that  all  books  and 
magazines  for  children  printed  from  it  should  be  banisht  from  the  home  and  school. 

Brevier  is  much  used  in  newspapers,  but  is  too  small  for  maga- 
zines or  books  for  young  folks. 

Bourgeois  is  much  used  in  magazines,  but  should  be  used  in  only 
those  school  books  to  which  a  brief  reference  is  made. 

Long  Primer  is  suitable  for  school  readers  for  the  higher 
and  intermediate  grades  and  for  textbooks  generally. 

Small  Pica  is  still  a  more  luxurious  type,  used  in  the 
North  American  Review  and  the  Forum. 

Pica  is  a  good  type  for  b3oks  for  small  children. 

Great  Primer  should  be  used  for 

the  first  reading  booL 

TESTS    OF    HEARING 

There  are  two  tests  of  hearing  in  common  use:  the 
watch  test  and  the  whisperd-speech  test.  Since  the  work 
of  Andrews  in  1904,  in  schools  the  whisperd-speech  test  is 
coming  into  general  use.  Rapeer  in  an  examination  of 
medical  inspection  in  twenty-five  cities  in  New  York  and 
New  England  found  that  the  whisperd-speech  test  was  the 
one  most  commonly  used.  Andrews  found  that  in  bildings 
the  intensity  of  sound  does  not  decrease  in  proportion  as 
the  distance  increases,  on  account  of  the  reflexion  of  sound 
waves  across  the  room.  In  the  room  which  he  used  hearing 
was  as  good  at  fifty  feet  as  at  forty  feet  and  as  good  at 
eighty  feet  (near  the  back  wall)  as  at  sixty- five  feet.  In  the 
watch  test  the  method  consists  in  finding  the  greatest  dis- 
tance at  which  persons  of  normal  hearing  can  hear  a 
certain  watch  tick,  and  then  finding  what  part  the  extreme 
range  of  the  person  being  tested  is  of  the  extreme  range  for 
normal  hearing.    The  tests  of  Andrews  showd  that  it  is  un- 


Testing  School  Children  for   Vision  and  Hearing  9 

safe  to  infer  that  because  I  can  hear  a  watch  tick  at  two- 
thirds  the  distance  that  persons  of  normal  hearing  can,  my 
hearing  is  two-thirds  as  good.1  In  the  whisperd-speech 
test,  series  of  two-figure  numbers  are  whisperd  to  a  person 
seated  a  certain  distance  away,  and  the  quality  of  his  hear- 
ing is  judged  by  comparing  the  percent  of  numbers  which 
he  hears  correctly  with  the  percent  obtaind  by  persons  of 
normal  hearing.  Thus  the  range  is  kept  constant.  There 
are  other  reasons  for  preferring  the  whisperd-speech  test 
to  the  watch  test.  The  rich  variety  of  sounds  in  speech 
make  the  hearing  of  a  watch-tick  an  unreliable  indication 
of  ability  to  hear  speech.  The  whisperd-speech  test  is 
better  suited  to  group  work.  On  the  other  hand  the  strength 
of  the  tick  at  a  fixed  range  is  constant,  while  it  takes  quite  a 
little  practis  to  produce  a  whisper  of  constant  strength.  All 
things  considerd  the  speech  test  is  much  to  be  preferd  for 
school  work. 

TESTING  HEARING  BY  WHISPERD-SPEECH 

We  shall  first  describe  the  method  of  testing  children 
of  the  four  upper  grades  and  those  older,  and  then  speak  of 
the  modifications  necessary  for  younger  children. 

1.  Establishing  the  range. — The  purpose  of  this  part 
of  the  test  is  to  find  a  distance  such  that  persons  of  normal 
hearing  can  hear  80-95%  of  all  the  numbers  spoken  to 
them.  The  only  materials  needed  are  a  sounder  and  a 
small  supply  of  rubber  corks  number  00  which  may  be  ob- 
taind from  the  supply  houses.  The  kind  of  place  best 
suited  for  tests  of  hearing  is  a  room  or  hall  upwards  of 
fifty  feet  long,  quiet  within  and  without.  The  range  may 
be  shortend  by  the  use  of  screens  or  by  the  speaker's  stand- 
ing in  an  adjoining  room  with  the  connecting  door  open, 
or  one  may  cultivate  a  faint  whisper.  By  these  means  the 
ordinary  recitation  room  can  be  used;  but  there  should  be 
no  children  in  it  besides  those  who  are  being  tested.  Select 
ten  children  who  are  supposed  to  be  of  normal  hearing 
and  seat  them  at  one  end  of  the  room,  one  behind  another 
with  their  left  ears  toward  the  examiner.     Arrange  them 


1  Directions  for  the  watch  test  may  be  found  in  Whipple.  G.  M..  Manual  of 
Mental  and  Physical  Tests,  2nd  edition,  1914,  Pt.  I,  p.  207. 


10  The  Normal  School  Quarterly 

in  an  arc  of  such  radius  that  those  at  the  ends  will  be  no 
farther  away  from  the  speaker  than  those  in  the  middle. 
Supply  them  with  paper  and  pencil,  arm-rests  or  books  on 
which  to  write,  and  rubber  corks.  Then  give  them  the 
following  directions. 

"I  am  going  to  whisper  to  you  some  numbers,  and 
after  each  number  I  shall  ask  you  what  it  was.  Do  not 
write  at  present.  Keep  your  faces  to  the  front  and  mouths 
closed.  A  click  with  the  sounder  is  a  signal  that  the 
number  is  coming  [here  the  examiner  should  illustrate]. 
New  close  the  right  ears  with  the  rubber  corks." 

The  examiner  should  now  take  a  position  thirty  feet 
from  the  children,  click  the  sounder,  make  one  normal  res- 
piration (in  and  out),  whisper  a  number  with  residual 
breth,  and  then  ask  each  child  in  turn  to  say  what  the  num- 
ber which  he  heard  was,  if  any.  He  should  then  move  closer 
or  farther  away  according  as  the  percentage  of  correct  an- 
swers is  too  low  or  too  high.  If  the  room  is  thirty  feet  or 
less  in  length,  insted  of  varying  his  position  the  speaker 
must  raise  or  lower  his  whisper  or  resort  to  the  other  expe- 
dients mentiond  above.  If  there  are  ten  children  each  cor- 
rect answer  is  worth  ten  and  each  one-half  correct,  five. 
From  the  point  of  view  of  spoken  speech  seventeen  for 
seventy  is  half  correct,  but  seventy-three  for  twenty-seven 
is  probably  worth  nothing.  If  seven  children  answerd 
correctly  and  three  half  correctly,  the  percentage  for  that 
number  is  85%.  Find  a  range  such  that  four  or  five  num- 
bers in  succession  run  between  80  and  95%  correct.  Then 
test  it  thoroly  by  giving  the  test  with  sixty  numbers,  now 
to  be  described.  If  most  of  the  group — say,  seven  or  eight — 
average  between  80  and  95%  with  each  ear,  the  range  may 
be  adopted  provisionally,  subject  to  such  modification  as 
later  experience  warrants. 

2.  Testing  children  of  the  upper  grades :  group  test. — 
This  test  consists  in  giving  thirty  numbers,  in  series  of  ten, 
to  each  ear.  As  many  as  eight  persons  may  be  tested  at. 
once.  The  numbers  should  be  red  in  the  following  way: 
1  click  with  the  sounder  as  a  warning  signal  followd  by 
1  respiration  and  a  number  ;  2  clicks  to  indicate  that  the: 
number  has  been  spoken  followed  by  2  respirations,  which. 


Testing  School  Children  for  Vision  and  Hearing  11 

is  the  time  allowd  for  writing;  then  1  click  again,  etc.  Let 
the  children  rest  one  minute  with  corks  removed  after  each 
ten  numbers,  and  three  minutes  after  each  third  series. 
After  thirty  numbers  have  been  spoken  to  the  left  ear,  have 
the  children  face  about  and  test  the  right  ear  in  the  same 
way.    The  directions  are  as  follows: 

"I  am  going  to  whisper  thirty  numbers  to  you  as  a  test 
of  the  hearing  of  your  left  ear,  and  then  thirty  more  to  the 
right  ear.  Write  your  name  in  full,  your  grade,  and  the 
date  in  the  upper  right-hand  corner  of  the  sheet  of  paper. 
On  the  left  half  of  the  first  line  write  Left  ear,  and  on  the 
right  half,  Right  ear.  Across  the  second  line  under  the 
words  Left  ear  write  the  Roman  numerals  I,  II,  III,  an  inch 
apart.  Under  the  words  Right  ear  write  the  numerals  IV, 
V,  VI.  The  sixty  numbers  which  I  am  going  to  read  to  you 
are  to  be  written  in  colums  of  ten  under  these  numerals. 
At  the  left  margin  of  the  sheet  beginning  with  the  third  line 
write  the  Arabic  numbers  1  to  10.  These  numbers  mean  that 
the  first  number  is  to  be  written  on  the  line  numbered  1, 
the  second  on  line  2,  etc.  //  you  do  not  hear  a  number, 
write  a  dash  and  jjass  to  the  line  below.  If  you  hear  only 
part  of  a  number,  put  it  down  with  a  dash  for  the  other 
part.  Do  not  look  at  me.  Look  straight  ahed  or  at  your 
paper.  Now  close  your  right  ears  with  the  corks.  Keep 
your  mouths  closed." 

It  is  well  to  give  the  children  a  practis  series  of  ten 
numbers,  having  an  assistant  stand  near  them  to  see 
whether  they  are  following  directions,  and  that  they  are 
not  copying. 

Numbers  for  test  of  auditory  acuity 


I 

II 

III 

IV 

V 

VI 

VII 

VIII 

IX 

X 

6 

84 

19 

90 

25 

14 

8 

52 

73 

24 

29 

69 

53 

7 

13 

31 

93 

35 

41 

95 

42 

17 

34 

39 

46 

9 

27 

64 

16 

62 

87 

92 

28 

62 

7 

65 

60 

81 

95 

49 

53 

33 

97 

84 

54 

98 

15 

6 

57 

80 

94 

26 

45 

21 

70 

76 

7  4 

19 

38 

,1 

70 

50 

72 

56 

91 

40 

36 

78 

20 

16 

35 

75 

60 

75 

83 

23 

49 

40 

89 

3 

18 

48 

3 

43 

68 

52 

82 

23 

64 

58 

61 

1 

86 

18 

92 

87 

51 

97 

2 

37 

12  The  Normal  School  Quarterly 

Time  will  be  saved  by  having  printed  or  mimeograft 
blanks,  and  by  having  the  next  group  arrive  promptly  after 
the  first  group  has  finisht.  If  several  teachers,  or  the  prin- 
cipal and  a  teacher,  test  the  entire  school,  greater  skill  and 
speed  will  be  developt.  In  any  case  the  same  person  should 
call  the  numbers  for  all  the  children  in  one  room,  as  the 
denominator  for  each  child's  fraction  of  normal  hearing 
is  the  room  average.  Always  dense  the  corks  thoroly  before 
using  them  a  second  time,  for  example,  by  shaking  them 
vigorously  in  90%  alcohol.  Children  should  not  be  told 
the  outcome  of  the  tests.  If  the  hearing  is  sufficiently 
sub-normal,  notify  the  parent  in  writing. 

Grading  the  tests. — In  the  test  with  sixty  numbers  the 
grading  should  be  done  at  a  later  time.  As  explaind  in 
finding  the  range,  allow  ten  for  each  number  correct  and 
five  for  each  number  half  correct.  Average  the  three  series 
to  the  left  ear,  and  the  three  to  the  right  ear  and  record  the 
two  averages.  If  poor  results  are  due  to  defness,  all  three 
series  will  be  poor.  If  one  or  two  of  the  three  to  one  ear  are 
high  while  the  others  are  low,  the  result  is  suspicious.  It 
may  be  due  to  poor  attention,  to  not  comprehending  di- 
rections, to  outside  disturbances,  or  to  the  examiner's 
lowering  his  voice.  If  due  to  either  of  the  last  two,  the  series 
which  is  poor  should  be  so  with  all  the  children  in  the 
group.  Whatever  it  is  due  to,  give  the  person  another  test. 
Retest  individually  all  children  who  average  60%  or  below 
with  either  ear.  (See  individual  test  below.)  A  child's 
auditory  acuity  is  judged  by  comparing  him  with  the  others 
tested  under  the  same  conditions.  Thus  if  the  averages  of 
all  the  children  in  the  room  are  85%  for  the  left  ear  and 
83%  for  the  right  ear,  and  a  certain  child's  averages  are 
L.  E.  80%,  and  R.  E.  90%,  his  left  ear  is  80-85  or  94%,  and 
his  right  ear  90-83  or  108%  normal. 

3.  Testing  children  of  the  lower  grades :  individual 
test. — Children  of  the  four  lower  grades  should  be  tested 
individually.  The  range  is  the  same  as  in  the  group  test. 
As  most  children  will  not  require  over  two  minutes  each, 
give  the  following  directions  to  eight  or  ten  children  at 
once  : 

"I  am  going  to  test  your  hearing  by  whispering  some 


Testing  School  Children  for  Vision  and  Hearing  13 

numbers  to  you.  When  I  click  this  sounder  [illustrate] 
it  means  attention,  the  number  is  coming.  As  soon  as  you 
have  heard  the  number  tell  me  what  it  is.  Now  stand  here 
[placing  a  child  at  one  end  of  the  range],  face  this  way, 
[showing  him],  close  your  mouth,  and  close  your  right  ear 
with  your  right  forefinger,  putting  it  gently  but  firmly  into 
your  ear." 

Have  the  child  moisten  the  finger  in  a  glass  of  water 
before  putting  it  into  the  ear.  Then  give  him  ten  numbers 
to  each  ear,  keeping  track  either  mentally  or  on  a  sheet  of 
paper  of  the  number  or  numbers  wholly  incorrect,  and  of 
those  partly  incorrect.  At  the  end  of  each  series  the  exam- 
iner should  record  the  grade  for  that  series.  If  it  is  80%  or 
above,  ten  numbers  are  enuf.  If  it  falls  below  80%  give  the 
child  one  or  two  more  series  to  the  same  ear,  until  you  are 
satisfied  as  to  his  condition.  No  later  retest  is  necessary. 
Use  the  room  average  in  determining  his  fraction  of  normal 
hearing  for  final  entry  in  the  school  records. 

For  all  children  who  average  50%  of  the  room  average 
or  less  with  either  ear  a  notis  should  be  sent  to  the  parents 
stating  the  result  of  the  test,  and  advizing  that  a  physician 
be  consulted.  The  same  advice  should  be  given  for  all  chil- 
dren with  discharging  ears,  whatever  the  result  of  the  test. 
Children  who  are  defectiv  in  hearing  should  always  be  given 
seats  which  favor  them.  If  the  child  is  only  slightly  def, 
a  seat  a  little  forward  of  the  center  of  the  class  is  best.  If 
he  is  very  def,  something  will  have  to  be  sacrificed,  and  it 
is  more  important  to  hear  the  teacher  than  the  class.  As  it 
is  easier  to  hear  a  speaker  if  one  can  look  at  him,  a  seat 
near  the  inner  edge  of  the  class  is  better  than  those  in  the 
center  where  it  is  inconvenient  to  turn  around.  If  the  child 
is  def  in  one  ear  only  he  should  be  seated  with  the  good  ear 
toward  the  teacher  and  the  class. 

GETTING  RESULTS 

The  results  of  the  tests  of  both  sight  and  hearing  should 
be  entered  on  printed  record  cards,  one  for  each  pupil,  with 
colums  for  the  results  of  four  biennial  examinations.  The 
card  should  remain  in  the  room  with  the  pupil,  and  go  with 


1  i  The  Normal  School  Quarterly 

him  when  he  is  promoted.    A  sample  card  is  given  herewith 
which  may  be  enlarged  to  accommodate  other  kinds  of  tests. 


Name  . 

I)ate  of  Examination. . . . 

Grade  2 

Sight 

L.  E.  Vis.  Ac. 

6-10 

Hy.  or  My. 

My. 

Astig. 

No 

E.  E.  Vis.  Ac. 

5-10 

Hy.  or  My. 

My. 

Astig. 

3-3 

Squint 

No 

Wears  glasses 

No 

Hearing 

L.  E. 

90% 

R.  E. 

80% 

Record  Card 

Date  of  birth. 

Grade  Grade G  rade . 


Treatment  recommended 


Action  taken  after  1  month 


Remarks: 


I  Sight.    Yes 

(  Hearing 

(  Sight.    Glasses  secured 

(  Hearing 


A  number  of  school  systems  in  this  country  examin 
the  sight  and  hearing  of  all  children  annually,  but  once 
every  other  year  is  frequent  enuf.  This  is  more  nearly  in 
accord  with  the  practis  abroad,  and  has  the  sanction  of 
Dr.  Cornell,  the  Director  of  Medical  Inspection  of  the  Phil- 
adelphia schools.  What  is  needed  is  not  so  much  a  frequent 
examination  as  an  effectiv  follow-up  system  for  securing 
proper  action  by  the  parents.  If  a  child's  vision  in  either 
eye  is  6-10  or  poorer,  or  if  astigmatism  is  present  at  all,  or 
if  he  squints,  if  his  hearing  in  either  ear  is  50%  of  normal 
or  poorer,  or  if  he  has  discharging  ears,  a  notis  should  be 
sent  the  parents  advizing  them  to  consult  a  physician  or 


Testing  School  Children  for  Vision  and  Hearing  In 

oculist  or  aurist.  Consultations  are  not  cheap,  and  such 
advice  should  be  given  with  caution  in  order  to  be  effecliv. 
If  the  teacher  can  find  an  opportunity  to  urge  the  matter 
personally,  the  chances  of  success  are  much  greater.  It  is 
probably  needless  to  add  that  tact  and  persistence  in  getting 
parents  to  act  are  simply  invaluable  in  making  examina- 
tions of  this  kind  a  success.  To  judge  from  the  returns 
from  ten  cities,  reported  by  Gulick  and  Ayers,  of  the  cases 
recommended  for  treatment  15  to  25%  were  actually  treated. 
This  is  where  the  teacher  makes  the  examination.  Where 
physicians  make  the  examination,  the  figures  are  about  10% 
higher,  and  if  there  is  a  nurse  or  home  visitor  the  percent- 
age runs  from  40  to  70%.  If  these  figures  are  somewhat 
disappointing,  it  must  be  rememberd  that  the  whole  move- 
ment is  very  recent,  and  the  community  has  to  be  educated. 
One  of  the  usual  forms  of  notises  to  parents  is  as  follows : 

IRVING  SCHOOL  HELTH  NOTIS 

Mr... 

Dear  Sir: — This  is  to  notify  you  that 

is  in  need  of  professional 

attention  for  defectiv 

You  are  urged  to  consult  a  physician  or  an  eye  ear  special- 
ist. 

Yours  very  truly, 

Date :   


Teacher Grade 

The  word  eye  or  ear  may  be  crost  out  when  the  teacher 
or  principal  fills  out  the  notis. 

REFERENCES 

Cornell,  W.  S.  Helth  and  Medical  Inspection  of  School 
Children.  1912,  614  pp.  Frice  $3.  F.  A.  Davis  &  Co.,  Phil- 
adelphia.    Primarily  for  principals  and  school  physicians. 


16  The  Normal  School  Quarterly 

Probably  the  best  single  book  dealing  with  all  fases  of  med- 
ical inspection  in  the  United  States. 

Gulick  and  Ayres.  Medical  Inspection  of  Schools. 
Revized  edition,  1913,  233  pp.  $1.50.  Survey  Associates 
Inc.,  New  York.  Contains  a  resume  of  the  report  of  the 
Russell  Sage  Foundation  of  1911,  and  many  other  valuable 
statistics;  also  an  account  of  the  methods  of  administering 
medical  inspection  in  the  United  States,  and  a  bibliografy. 

Rapeer,  L.  W.  School  Helth  Administration.  360  pp. 
$2.15.  Teachers  College,  New  York.  Similar  in  scope  to 
preceding  reference. 

Whipple,  G.  M.  Manual  of  Mental  anl  Physical  Tests. 
Revized  edition,  1914.  Pt.  I,  385  pp.  $2.25.  Warwick  & 
Yorke,  Baltimore.  An  authoritativ  and  comprehensiv 
manual  on  methods  of  conducting  school  tests.  Contains 
extensiv  bibliografies. 

Dresslar,  F.  B.  School  Hygiene.  1914.  369  pp.  $1.25. 
The  Macmillan  Co.,  New  York  and  Chicago.  Primarily  for 
teachers.  Contains  good  chapters  on  defects  of  vision  and 
hearing,  showing  how  they  affect  school  life. 

Howell,  W.  H.  Textbook  on  Physiology.  Fourth 
edition,  1911.  pp.  313-18,  contain  an  explanation  of  the 
causes  of  the  common  defects  of  vision. 

SUPPLY  HOUSES 

F.  A.  Hardy  &  Co.,  Silversmiths  Bldg.,  Chicago. 
C.  H.  Stoelting  Co.,  3037  Carroll  Ave.,  Chicago. 


3  0112105727280 


